The next time you intend to give your patient an antibiotic for a toothache or an endodontic infection, you may want to reconsider.
How often do we hear our patients say that taking antibiotics prior to an endodontic procedure can’t hurt because they’ve taken them for years? Or, they often say that they want to be safe and just take the antibiotics.
Many of our patients have been conditioned to believe that antibiotics can only help and are needed when they’re having tooth pain, including sensitivity to heat and cold. They also may believe that antibiotics are needed for any form of dental infection, no matter how localized and small it may be.
First and foremost, we frontline clinicians sincerely have our patients’ well-being in mind with respect to managing their pain and infections. But let’s admit that many of us and our patients are comforted when using antibiotics, because we mentally, legally, and sincerely believe they help clinically. However, we must ask ourselves if we are helping or potentially hurting our patients when exposing them to antibiotics.
The Institutions Weigh In
This past January, the American College of Physicians and the Centers for Disease Control and Prevention very publicly discussed the overuse of antibiotics. Although they reviewed the medical side of antibiotic overuse, their statements remind us of the ongoing discussions we in dentistry have had regarding the same issue.
In 2014, the ADA commented on the use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints. The practical conclusion was that “in general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental treatment to prevent prosthetic joint infection.”
In fact, over the years, there has been a clear trend in dentistry towards a reduced need for antibiotics.
We can’t always assume that antibiotics are safe or that they benefit our patients. For instance, patients who have received antibiotics for years for endodontic and dental treatments may not be okay if they continue to use them repeatedly.
Who is to say that your patients won’t develop an allergic reaction to an antibiotic, even if they have been taking it for years? How many of us develop allergies only after repeated exposures to certain allergens, including latex and seasonal allergies? What about other risks from antibiotic use? These may include the development of serious C. Difficile bacterial infections or the increased risk of resistance to antibiotics.
In 2004, the ADA said, “Any perceived potential benefit of antibiotic prophylaxis must be weighed against the known risks of antibiotic toxicity, allergy and the development, selection and transmission of microbial resistance.” Although the ADA commented on antibiotic prophylaxis, this should be kept in mind whenever antibiotics are used, including for root canal related matters.
In endodontics, there are some fundamental indications and scenarios that do and do not require antibiotics. Over the years, very often I’ve seen dentists recommended antibiotics for endodontic related pain or infections, when they had no clear clinical indications for their use and, unfortunately, did not help.
So, with your good intentions in mind, please think twice and be very calculated before recommending or administering antibiotics to your patients. Chances are they will not need them, and they may inadvertently cause more harm than good.
DISCLOSURE: Dr. Haas has no disclosures to make.
Dr. Manor Haas is a Certified Specialist in Endodontics in Toronto, Canada, and is extensively involved in continuing education to dentists with emphasis on advanced instrumentation, obturation, and the benefits of 3-D imaging in endodontics. He is a Fellow of the Royal College of Dentists of Canada and is on staff at the University of Toronto Faculty of Dentistry and the Hospital for Sick Children. He maintains a full-time private practice limited to endodontics and microsurgery in Toronto. He may be reached at manor@HaasEndoEducation.com.
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